En busca del buen morir / In search of a good death

La muerte siempre ha generado desconcierto, por lo que acompañar en este proceso de final de vida conlleva un alto compromiso existencial. Si a esta difícil tarea se le agregan los condicionantes hospitalarios o legales que sufren los enfermos en su agonía, estamos ante una muerte aterradora, muy distante de una partida que pueda ser considerada amorosa. Como sabemos, la palabra "clínica" hace referencia a la práctica de atender al pie de la cama del paciente, aliviando el dolor del que está por partir; sin embargo, el "corsé legal" de la muerte está alejando al médico de aquel que debiera recibir toda su atención y sus cuidados, atándole el brazo para acompañarlo en el buen morir. Deberíamos debatir y acordar una estrategia que enriquezca la experiencia del momento final de la vida, de modo que ese conjunto acotado de pacientes pueda elegir su forma de partir. Es de un valor incalculable despertar la compasión en este tema tan importante que preocupa al ser humano desde los inicios de la civilización. Sería muy fructífero que aprovechemos la transmisión de sabiduría de siglos de antiguas culturas que han sabido cuidar con humildad la vida hasta el instante de morir. (AU)

Death has always implied confusion, so accompanying this end-of-life process entails a highexistential commitment. If we add to this difficult task the hospital or legal constraints suffered bypatients in their agony, we are facing a terrifying death, very far from a departure that can be considered a loving one. As we know, the word "clinical" refers to the practice of caring for the patient very close to the bed, alleviating the pain of whom is about to leave; however, the "legal corset" of death is separating the doctor from the one who should receive all his attention and care, preventing him from accompanying the pacient in his/her good dying. We should discuss and agree on a strategy that enriches the experience of the end of life, so that patients could choose the way to leave. It is of incalculable value to awaken compassion on this important issue that has concerned human since the beggining of civilization. It would be very fruitful if we take advantage of the enormous wisdom of ancient cultures that have humbly cared for life until the moment of death. (AU)

The effect of preoperative application of butorphanol tartrate on the quality of recovery in patients undergoing thoracoscopic lobectomy / 中国医师杂志

Objective:To observe the effect of preoperative application of butorphanol tartrate on postoperative recovery quality in patients undergoing thoracoscopic lobectomy.Methods:A prospective selection was conducted on 96 lung cancer patients who underwent thoracoscopic lobectomy and were admitted to Linyi People′s Hospital from May 2021 to September 2021. They were randomly divided into observation group and control group using a random table number method, with 48 patients in each group. The observation group received intravenous injection of 0.02 mg/kg butorphanol tartrate 15 minutes before anesthesia induction; The control group was given an equal volume of physiological saline. The operation site, operation time, remifentanil dosage during operation, heart rate (HR) and mean arterial pressure (MAP) at each time point of admission (T 0), intubation (T 1), 5 min after intubation (T 2), extubation (T 3), 5 min after extubation (T 4), and 15 min into post-anaesthesia care unit (PACU) (T 5) were recorded; The awakening Restlessness score (RS), Ramsay score, Visual Analogue Scale (VAS) score at T 4 and T 5, the time required from completion to extubation, and postoperative anesthesia related adverse reactions were evaluated. Results:There was no significant difference in the operation site, operation time and remifentanil dosage between the two groups (all P>0.05). Compared with T 0, the HR at T 2, T 3 and T 4, MAP at T 1, T 2, T 3 and T 4 in the two groups decreased significantly (all P<0.05). The HR of the observation group at T 1 and T 3 was significantly lower than that of the control group, and the difference was statistically significant (all P<0.05). The VAS scores of T 4 and T 5 in the observation group were lower than those in the control group after surgery, while the Ramsay score were higher than those in the control group (all P<0.001). The incidence of postoperative restlessness, nausea and vomiting in the observation group was lower than that in the control group ( P<0.05). Conclusions:Administering 0.02 mg/kg butorphanol tartrate 15 minutes before anesthesia induction can improve the quality of recovery in patients undergoing thoracoscopic lobectomy, reduce restlessness and related adverse reactions during recovery.

Cefalea por abuso de medicamentos y sus marcadores clínicos / Medication overuse headache and its specific clinical markers

Resumen Introducción: Los marcadores clínicos de la cefalea por uso excesivo de medicación (CMA) se basan en la clasificación de las cefaleas desarrollada por la Sociedad Internacional de Cefaleas (IHS). Esta clasificación incluye sólo dos criterios: la frecuencia de los días de cefalea debe ser de 15 o más días al mes durante al menos tres o más meses; - y el número de días de uso excesivo de la medicación debe ser de 10 o 15 días al mes dependiendo del tipo de medicación. Sin embargo, los pacientes suelen tener otros marcadores clínicos asociados distintos, que la mayoría de los médicos pasan por alto durante la evaluación inicial. Metodología: Este estudio es un estudio prospectivo, longitudinal y observacional de 76 pacientes ingresados en la Unidad de Cefaleas del hospital DIPRECA. Todos ellos fueron diagnosticados de HMO según los criterios establecidos por su ICHD III beta.(1) Los pacientes recibieron un tratamiento estándar que incluía desintoxicación y medicación preventiva y fueron seguidos durante 6 meses. Se registraron los síntomas de interés en cada visita de seguimiento clínico y se administraron escalas de evaluación como Zung, MIDAS, HIT-6. Resultados: Los medicamentos sobreutilizados incluyeron antiinflamatorios no esteroideos (AINE), triptanes y cornezuelos. Los síntomas clínicos más significativos asociados fueron: despertar por la mañana con dolor de cabeza, despertar al paciente al amanecer por dolor de cabeza, dificultades de atención, depresión, dolor cervical y síndrome de dolor miofascial. Todos los síntomas mejoraron significativamente al iniciar el tratamiento, al igual que la calidad de vida medida por las escalas MIDAS y HIT-6. Discusión: Al evaluar a los pacientes con HMO, hay que tener en cuenta tanto los criterios diagnósticos de la ICHD III beta como los síntomas comunes y específicos que se observan en la mayoría de los casos de HMO.

Introduction: Clinical markers of medication overuse headache (MOH) are based on headache classification developed by the International Headache Society (IHS). This classification include only two criteria: frequency of headache days must be 15 or more days per month for at least three or more months; - and the number of days of overuse medication must be either 10 or 15 days per month depending on the type of medication. However, patients often have others distinct associated clinical markers, which are overlooked by most physicians during the initial evaluation. Methodology: This study is a prospective, longitudinal and observational study of 76 patients admitted to DIPRECA´s hospital Headache Unit. They were all diagnosed with, MOH according to the criteria established by the his ICHD III beta.(1) Patients were given standard treatment including detoxification and preventive medications and followed for 6 months. Symptoms of interest were recorded in at each clinical monitoring visit and assessment scales such as Zung, MIDAS, HIT-6 were administered. Results: Overused medications included nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and ergots. The most significant clinical symptoms associated were: awaking in the morning with headache, awaking the patient at dawn by headache, attention difficulties, depression, cervical pain and myofascial pain syndrome. All symptoms significantly improved when treatment began, as did quality of life as measured by MIDAS and HIT-6 scales. Discussion: In evaluating patients with MOH consider both the ICHD III beta diagnostic criteria and the common and specific symptoms seen in most cases of MOH.

Cirugía con despertar operatorio para procesos expansivos cerebrales. Reporte de 20 casos

Resumen: Introducción: La cirugía de lesiones expansivas cerebrales con paciente despierto es una técnica que se usa de forma cada vez más frecuente. Esto se debe a que es una técnica costo efectiva para realizar resección de tumores cerebrales de forma amplia y segura. Resultado: Se presentan 20 pacientes operados con dicha técnica. Se trató de 13 hombres y 7 mujeres, rango etario 16 - 67 años, portadores de 17 lesiones tumorales y 3 lesiones vasculares (angiomas cavernosos). Se realizaron 22 cirugías ya que dos pacientes se intervinieron 2 veces. Se logró resección supra-máxima en 3 casos, completa en 9, subtotal en 5 y parcial en 2 pacientes. Un paciente no se pudo operar debido a que presentó un despertar inadecuado y el procedimiento se suspendió. En cuanto a las complicaciones, 18% de los pacientes presentaron crisis intra-operatorias, pero las mismas no impidieron el desarrolló del procedimiento con normalidad luego de yugulada la crisis. Dos pacientes (9% de los procedimientos) presentaron un despertar inadecuado. En un caso la lesión se resecó completamente de todas formas, en el otro se suspendió el procedimiento. 18% de los pacientes presentaron una peoría funcional transitoria y un 4.5% presentó una peoría definitiva (paresia severa). Un solo paciente (4.5%) presentó una infección del colgajo que requirió retiro de la plaqueta ósea y colocación de una placa de acrílico en diferido. Conclusiones: Las cifras presentadas por los autores están en concordancia con las de los centros regionales e internacionales de referencia.

Abstract: Introduction: Expansive brain injury surgery with awake patients is a technique that is being used more and more frequently. This is because it is a cost-effective technique for performing brain tumor resection widely and safely. Outcome: Twenty patients operated with this technique are presented. There were 13 men and 7 women, age range 16 - 67 years, carriers of 17 tumor lesions and 3 vascular lesions (cavernous angiomas). 22 surgeries were performed since two patients underwent surgery twice. Supra-maximal resection was achieved in 3 cases, complete in 9, subtotal in 5, and partial in 2 patients. One patient could not be operated on due to inadequate awakening and the procedure was suspended. Regarding complications, 18% of the patients presented intra-operative seizures, but they did not prevent the normal development of the procedure after the crisis was jugulated. Two patients (9% of the procedures) had inadequate awakening. In one case the lesion was completely resected anyway, in the other the procedure was suspended. 18% of the patients presented a transitory functional deterioration and 4.5% presented a definitive worsening (severe paresis). Only one patient (4.5%) had a flap infection that required removal of the bone plate and placement of a delayed acrylic plate. Conclusions: The figures presented by the authors are in accordance with those of the regional and international reference centers.

Resumo: Introdução: A cirurgia de lesão cerebral extensiva com pacientes acordados é uma técnica cada vez mais utilizada. Isso ocorre porque é uma técnica econômica para realizar a ressecção de tumor cerebral de forma ampla e segura. Resultado: São apresentados 20 pacientes operados com essa técnica. Eram 13 homens e 7 mulheres, com idades entre 16 e 67 anos, portadores de 17 lesões tumorais e 3 lesões vasculares (angiomas cavernosos). Foram realizadas 22 cirurgias, pois dois pacientes foram operados duas vezes. A ressecção supra-máxima foi alcançada em 3 casos, completa em 9, subtotal em 5 e parcial em 2 pacientes. Um paciente não pôde ser operado devido ao despertar inadequado e o procedimento foi suspenso. Em relação às complicações, 18% dos pacientes apresentaram convulsões no intra-operatório, mas não impediram o desenvolvimento normal do procedimento após a jugulação da crise. Dois pacientes (9% dos procedimentos) tiveram despertar inadequado. Em um caso a lesão foi totalmente ressecada de qualquer maneira, no outro o procedimento foi suspenso. 18% dos pacientes apresentaram uma deterioração funcional transitória e 4,5% apresentaram piora definitiva (paresia grave). Apenas um paciente (4,5%) apresentou infecção do retalho que exigiu a retirada da placa óssea e colocação de placa acrílica retardada. Conclusões: Os números apresentados pelos autores estão de acordo com os dos centros de referência regionais e internacionais.

Variability of anesthetic depth in total intravenous anesthesia vs balanced anesthesia using entropy indices: a randomized, crossover, controlled clinical trial / Variabilidad de la profundidad anestésica en anestesia total intravenosa vs. anestesia general balanceada usando índices de entropía. Un ensayo clínico aleatorizado, cruzado y controlado

Abstract Introduction: Total intravenous anesthesia (TIVA) and balanced anesthesia (BA) are the most commonly used anesthetic techniques. The differences are the variability of the depth of anesthesia between these techniques that might predict which one is safer for patients and presents a lower risk of intraoperative awakening. Objective: To determine whether a difference exists in the variability of depth of anesthesia obtained by response entropy (RE). Methods: A crossover clinical trial was conducted on 20 healthy patients receiving upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (a) target-controlled infusion of propofol using the Schnider model at a target concentration of 2.5 µg/mL for 15 minutes and a 10-minute washout, followed by sevoflurane administration at 0.8 minimal alveolar concentration (MAC) for the reminder of the surgery, or (b) the reverse sequence. Differences in the variability of the depth of anesthesia using RE were evaluated using paired t-test. Results: The treatment effect showed no significant difference in the average values of RE, during TIVA = 97.23 vs BA 97.04 (P = 0.39). Carry Over (-4.98 vs 4.08) and Period (100.3 vs 94.68) effects were not significantly different. Conclusion: The present study suggests that both anesthetic techniques are equivalent in terms of the stability of the depth of anesthesia. It is important to keep testing the determinants of the efficacy of different populations because the individual behaviors of patients might ultimately tip the scale.

Resumen Introducción: La anestesia total intravenosa (TIVA, por sus siglas en inglés) y la anestesia balanceada (AB) son las técnicas anestésicas más comúnmente utilizadas. La diferencia está en la variabilidad de la profundidad de la anestesia entre estas dos técnicas, lo cual pudiera predecir cuál es más segura para los pacientes y representar un menor riesgo de despertar intraoperatorio. Objetivo: Determinar si existe alguna diferencia en la variabilidad de la profundidad de la anestesia obtenida según los índices de entropía de respuesta (ER). Métodos: Se llevó a cabo un estudio clínico cruzado en 20 pacientes sanos que se sometieron a cirugía ortopédica ambulatoria de miembros superiores o inferiores. Los pacientes se asignaron aleatoriamente así: a) infusión controlada por objetivo (TCI, por sus siglas en inglés) de propofol, utilizando el modelo Schnider a una concentración objetivo de 2,5 µg/mL durante 15 min y un período de lavado de 10 minutos, seguido de la administración de sevoflurano a 0,8 de concentración alveolar mínima (CAM) durante el tiempo restante de la cirugía; o b) la secuencia inversa. Las diferencias en la variabilidad de la profundidad de la anestesia utilizando entropía de respuesta se evaluaron utilizando la prueba t pareada. Resultados: El efecto del tratamiento no mostró ninguna diferencia significativa en los valores promedio de entropía de respuesta (ER) durante TIVA = 97,23 vs. AB 97,04 (P = 0,39). Los efectos de arrastre (-4,98 vs. 4,08) y período (100,3 vs. 94,68) no fueron significativamente diferentes. Conclusiones: El presente estudio sugiere que ambas técnicas anestésicas son equivalentes en términos de estabilidad de la profundidad de la anestesia. Es importante continuar probando los factores determinantes de eficacia en las distintas poblaciones, ya que el comportamiento individual de cada paciente pudiera finalmente inclinar la balanza.

O que resta da adolescência: despertar nas fronteiras e nos fronts / Lo que queda de la adolescencia: el despertar en las fronteras y en los frentes / What remains of adolescence: awakening at the borders and on the fronts

Os processos dos adolescentes diante dos dilemas humanos relativos à sexualidade, morte, pertença e transformação social contam a sua própria história, mas dizem também sobre o modo como cada sociedade concebe as modalidades de inscrição do sujeito no laço social, assim como da sua disponibilidade às transformações sociais. Neste artigo vamos demonstrar os impasses nos destinos da adolescência quando o outro social, em vez de interpelar, acompanhar e apostar no adolescente transforma suas fronteiras em opacidades intransponíveis, ao modo de um front de guerra, impondo impedimentos à sua pertença ao laço social. Vamos cotejar falas dos adolescentes da peça de teatro de Frank Wedekind, de 1891, O Despertar da Primavera, com falas de adolescentes das margens das grandes cidades brasileiras. Vamos demonstrar a articulação da sexualidade à cena social e política, assim como situar o estatuto do ato diante dos impasses do adolescente frente ao lugar que lhe é ofertado no discurso social. Pode-se escutar o que resta da adolescência: a construção de uma narrativa ficcional que permita construir e nortear a sua invenção de um lugar para existir.

Los procesos de los adolescentes frente a dilemas humanos relacionados con la sexualidad, la muerte, la pertenencia y la transformación social cuentan su propia historia, pero también cuentan la forma en que cada sociedad concibe las modalidades de inclusión del sujeto en el vínculo social, así como su disponibilidad para transformaciones sociales En este artículo, demostraremos los callejones sin salida en los destinos de la adolescencia cuando el otro social, en lugar de cuestionar, acompañar y apostar al adolescente transforma sus fronteras en opacidades insuperables, como un frente de guerra, imponiendo impedimentos para su pertenencia al vínculo social. Compararemos los discursos de los adolescentes en la obra de 1891 de Frank Wedekind, El Despertar de la Primavera, con los discursos de adolescentes de los márgenes de las grandes ciudades brasileñas. Vamos a demostrar la articulación de la sexualidad en la escena social y política, así como a situar el estatuto del acto en vista de los impases de los adolescentes en relación con el lugar que se les ofrece en el discurso social. Puedese escuchar lo que queda de la adolescencia: la construcción de una narrativa ficticia que te permite construir y guiar tu invención de un lugar para existir.

The processes of adolescents vis-à-vis human dilemmas related to sexuality, death, belonging and social transformation tell their own story, but they also tell about the way in which each society conceives the modalities of the subject's inclusion in the social bond, as well as its availability to social transformations. In this article we will demonstrate the impasses in the fates of adolescence when the social other, instead of questioning, accompanying and betting on the adolescent turns its borders into insurmountable opacities, like a war front, imposing impediments to their belonging to the social bond. We will compare the adolescents' speeches in Frank Wedekind's 1891 play, The Awakening of Spring, with speeches by adolescents from the margins of large Brazilian cities. We are going to demonstrate the articulation between sexuality and the social and political scene, as well as to situate the statute of the act in view of the adolescents' impasses in relation to the place offered to them in the social discourse. One can hear what remains of adolescence: the construction of a fictional narrative that allows building and guiding their invention of a place to exist.

Optimal dosage of dexmedetomidine on prevention of agitation induced by sevoflurane anesthesia in children / 中国临床药理学与治疗学

AIM: To explore the optimal dosage of dexmedetomidine for prevention of agitation induced by sevoflurane anesthesia in children. METHODS: One hundred and sixty ASA -Ⅱ pediatric patients, who underwent indirect inguinal hernia or hydrocele were randomly divided into 4 groups: C group (saline group), D0.2 group (dexmedetomidine 0.2 μg/kg), Group D0.4 (dexmedetomidine 0.4 μg/kg); D0.6 group (dexmedetomidine 0.6 μg/kg), 40 cases in each group. The dexmedetomidine was treated with intravenous infusion of the same volume of saline at 10 min before the induction of anesthesia. Observation with induction period and intraoperative hemodynamic situation, postoperative FLACC behavior score, Ramsay sedation scores, extubation time, adverse reactions, such as respiration depression (SpO20.05). The case of postoperative agitation in the group D0.4 (12 cases), D0.6 (8 cases) lower than the group C (23 cases) and D0.2 (16 cases) (P0.05).CONCLUSION:The usage of 0.4 μg/kg dexmedetomidine for the pediatric inguinal hernia or hydrocele surgery under the anesthesia of sevoflurane has the characteristics of stable hemodynamics during the operation, reducing the incidence of restlessness after sevoflurane anesthesia, not affecting the recovery of children, and not increasing adverse reactions.

Evaluation of the University of the Philippines Manila “Awakening Seminars”

Background@#Staff development is essential in sustaining organizational efficiency. In 2016, the University of the Philippines Manila started conducting the “Awakening Seminars” among administrative personnel to foster smooth interpersonal relationships and operational efficiency. @*Objectives@#This study was commissioned to determine the value of the seminars. It evaluated the trainees' perceived reactions, learning, and overall change in behaviors towards their work at the university. @*Methodology@#Out of 321 personnel who completed the seminars, 96 were calculated as sample size. Participants accomplished a survey questionnaire and 67 valid responses were collected. Data were analyzed using means and standard deviations according to Kirkpatrick's Evaluation Model from Level 1: Reactions, Level 2: Learning, to Level 3: Behavior. Different ratings were compared with selected variables using analysis of variance. @*Results@#Seven seminars were conducted from March 2016 to January 2017. Mean ratings showed that the seminars were well organized, relevant, and helped them appreciate their work, colleagues, and their workplace environment. Participants have high morale and felt privileged being in UP. Analysis of variance tests showed that evaluation ratings did not differ significantly with monthly take-home pay, tenure, performance, and job category. While these ratings are not directly translated as operational efficiency, results suggest participants' commitment to the university's goals. @*Conclusion@#UP Manila personnel appreciated the “Awakening” staff development program and can be replicated to all support personnel of the colleges.

Propuesta de protocolo en pacientes comatosos tras lesión cerebral traumática grave / Protocol proposal in comatose patients after severe traumatic brain injury

Resumen Introducción: Para analizar cuál es la mejor alternativa para la recuperación del paciente comatoso tras la lesión cerebral traumática grave en su contexto agudo, entre 1-6 semanas tras el evento traumático, se realizó una búsqueda bibliográfica sistemática. Metodología: La búsqueda empleó las principales bases de datos (Pubmed, Embase, Ovid y Cochrane) con la finalidad de discernir qué terapias son las más propicias para una correcta mejora neurocognitiva del enfermo. Se profundizará en la estimulación sensorial, las diversas instrucciones que se han recopilado sobre su aplicación clínica, el por qué de su efectividad, cuáles son los mejores tipos de estimulación y el fenómeno de habituación. Resultados: Este campo será el de la estimulación sensorial multimodal: por un lado, el uso de la estimulación sensorial que surge de los familiares y que se muestra ciertamente efectiva; y por otro lado, la realización de sesiones en las que intervenga personal del hospital y que estimule los diferentes sentidos. A partir de ciertos estudios se deducirá y comprobará que habrá un efecto positivo significativo al combinar ambas terapias. Esta unión sinérgica terapéutica será la que se pueda protocolizar y llevar a cabo en cualquier hospital. Conclusiones: Por tanto, se presenta el tratamiento terapéutico definitivo para pacientes clínicamente estables que han sufrido una LCT grave en un contexto agudo. Se debe destacar que el principal objetivo de la propuesta es aportar indicaciones a partir de la experiencia clínica sobre cómo se tienen que hacer los diferentes tipos de estimulación para obtener un resultado favorable.

Introduction: To analyze which is the best alternative for the recovery of the comatose patient after severe traumatic brain injury in its acute context, between 1-6 weeks after the traumatic event, a systematic bibliographic search was carried out. Methodology: The search used the main databases (Pubmed, Embase, Ovid and Cochrane) in order to discern which therapies are most conducive to a correct neurocognitive improvement of the patient. The sensory stimulation will be deepened, the various instructions that have been compiled about its clinical application, the why of its effectiveness, which are the best types of stimulation and the habituation phenomenon. Results: This field will be that of multimodal sensory stimulation: on the one hand, the use of sensory stimulation that emerges from the relatives and that is certainly effective; and on the other hand, the realization of sessions in which hospital personnel intervene and stimulate the different senses. From certain studies it will be deduced and verified that there will be a significant positive effect when combining both therapies. This synergistic therapeutic union will be the one that can be protocolized and carried out in any hospital. Conclusions: Therefore, definitive therapeutic treatment is presented for clinically stable patients who have suffered a severe TBI in an acute context. It should be noted that the main objective of the proposal is to provide indications based on clinical experience on how different types of stimulation have to be done in order to obtain a favorable result.

Monitorización automática de estados de sedación en señales electroencefalográficas / Automatic monitoring of sedation states in electroencephalographic signals

La anestesia general proporciona al paciente estados de inconciencia, amnesia y analgesia, sin embargo, se reportan casos de despertar intraoperatorio. Debido a la incidencia de este fenómeno y sus efectos psicosomáticos, el Centro de Estudios de Neurociencias, Procesamiento de Imágenes y Señales en la Universidad de Oriente, y el Hospital General Juan Bruno Zayas Alfonso ambos en Santiago de Cuba, Cuba, implementan una metodología que permita detectar automáticamente estados de sedación anestésica aplicando Inteligencia Artificial. Para esto se emplearon las señales registradas por el canal electroencefalográfico F4, nueve parámetros espectrales, las Máquinas de Soporte Vectorial y los Sistemas Neuro-Difusos. En el reconocimiento automático de los estados de Sedación Profunda, Moderada y Ligera se logró una Exactitud de 96.12 por ciento, 90.06 por ciento y 90.24 por ciento respectivamente con las Máquinas de Soporte Vectorial, por lo que se propone el uso del canal electroencefalográfico F4 en la detección de estados anestésicos(AU)

General anesthesia provide the patient states of unconsciousness, amnesia and analgesia, however, cases of intraoperative awareness are reported. Due to the incidence of this phenomenon and the psychosomatic effects it causes, the Neuroscience Studies Center, Images and Signals Processing at the University of Oriente, and the General Hospital Juan Bruno Zayas Alfonso both in Santiago de Cuba, Cuba, implement a methodology that allows the automatic detection of anesthetic sedation states applying Artificial Intelligence. For this, the signals recorded by the electroencephalographic channel F4, nine spectral parameters, the Support Vector Machines and the Neuro-Fuzzy Systems were used. In the automatic recognition of the Sedation States: Profound, Moderate and Mild an Accuracy of 96.12 percent, 90.06 percent and 90.24 percent respectively was achieved with the Support Vector Machines, so the use of the electroencephalographic channel F4 is proposed in the detection of anesthetic states(AU)

Application of EEG BIS monitor in precision anesthesia / 中国医学装备

Objective:To study the application value of electroencephalograph bispectral index (EEG-BIS) monitor in precision anesthesia and its effect on postoperative awakening time.Methods:A total of 100 patients who prepared to undergo thyroid surgery were randomly divided into observation group (n=50) and control group (n=50) .Under the same anesthesia way of the two groups, observation group adopted the results from EEG-BIS monitor to adjust the depth of anesthesia for patients, and control group adopted routine monitoring included weight, blood pressure and heart rate to adjust the depth of anesthesia.The amount of anesthetic and the awakening time of the patients in the two groups were observed and recorded, and the incidence of postoperative adverse events between the two groups were further compared.Results:The amount of propofol of observation group was significantly larger than that of control group (t=2.72, P<0.05) .And the awakening time, extubation time and the time of leaving PACU of observation group were significantly less than those of control group (t=4.45, t=4.83, t=5.92, P<0.05) .The differences of blood pressure at 20 min, 30 min and 60 min after patients underwent thyroid surgery between the two groups were significant (t=2.87, t=3.90, t=2.76, P<0.05) .Conclusion:BIS monitor can guide the adjustment for the depth of anesthesia during operation, and reduce the amount of general anesthetics of patients and shorten the awakening time in PACU, which is worthy in clinical application.

Algunas posiciones subjetivas frente a lo pulsional en los sueños / Algumas posições subjetivas frente ao impulso nos sonhos / Some subjective positions in view of the drive in dreams / Quelques positions subjectives face à la pulsion dans les rêves

Este artículo trata sobre la inserción de la pulsión en el sueño y la posición subjetiva frente al mismo. Se distinguen tres posiciones: una defensiva, otra más abierta, y una posición decidida, propia de los análisis avanzados. Se utilizan textos freudianos para situar las dos primeras y textos sobre resultados del pase para la tercera. Se concluye que el análisis permite cambiar la forma de recepción de los propios sueños, favoreciendo otras funciones, diferentes de la de ser "el guardián del dormir ".

Este artigo aborda a inserção da pulsão no sonho e a posição do sujeito ante ela. Encontramos três posições diferentes: uma posição defensiva, uma posição mais aberta e uma posição decidida, típica da análise avançada. Os textos freudianos são usados para situar as duas primeiras, e os textos sobre os resultados, da passagem para a terceira. Conclui-se que a análise permite mudar a forma de receber os sonhos, favorecendo outras funções, além de ser "o guarda do dormir ".

This paper focuses on the point of insertion of Freudian drive (Trieb) into dreams and the position of the subject towards it. We distinguish three positions: a defensive one, another more open, and a third that is a position of determination, typical of advanced analysis. Freudian texts are used to describe the first two positions, and many texts to describe the passing into the third one. We conclude that the analysis allows changes in the way of receiving our own dreams, favoring other functions besides being "the guardian of sleep".

Cet article examine le surgissement de la pulsion dans le rêve et la position du sujet face à celle-ci. Trois positions sont différenciées: une défensive, une autre plus ouverte, et une troisième position, décidée, propre des analyses avancées. Les écrits freudiens sont utilisés pour situer les deux premières et les textes sur les résultats du passage pour la troisième. Nous parvenons à la conclusion que l'analyse permet d'altérer la façon de recevoir les rêves et ainsi de favoriser d'autres fonctions que celle du «gardien du sommeil¼.

Dieser Artikel beschäftigt sich mit der Manifestation des Triebs im Traum und der entsprechenden Positionierung des Subjekts dazu. Es werden drei Positionen unterschieden: eine defensive, eine offenere und eine entschiedene Position, wobei die letzte für die fortgeschrittene Analyse typisch ist. Freuds Texte werden als Referenz verwendet, um die ersten zwei in einen Zusammenhang zu stellen und Texte über die Ergebnisse des Überganges um die Dritte zu situieren. Wir kommen zum Schluss, dass die Analyse es ermöglicht, die Art und Weise wie die Träume empfangen werden zu ändern, wobei andere Funktionen begünstigt werden, in Ergänzung zu derjenigen des „Hüters des Schlafes ".

Effects of low-dose epinephrine on cerebral oxygen saturation and awakening time during one-lung ventilation: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effects of low-dose epinephrine on cerebral oxygen saturation (rScO2) and awakening time during one-lung ventilation (OLV) for thoracic surgery. Methods    Thirty consecutive patients undergoing lobectomy from March to July 2016 in our hospital were randomly divided into an epinephrine group (n=15, 8 males and 7 females at an average age of 58.70±11.40 years) or a saline group (n=15, 7 males and 8 females at an average age of 57.00±11.40 years). They were continuously infused with 0.01 μg/(kg·min) epinephrine or saline after general induction. Hemodynamics was maintained ±20% of the baseline value. All patients were ventilated by a pressure control mode during OLV with tidal volume of 5-8 ml/kg and end-tidal carbon dioxide tension (EtCO2) of 35-45 mm Hg. Regional cerebral oxygen saturation (rScO2) was monitored using near-infrared spectroscopy (NIRS) continuously. Results    Compared with the saline group, the epinephrine group had a high rScO2 during OLV, with a statisitical significance at OLV 40 min and 50 min (67.76%±4.64% vs. 64.08%±3.07%, P=0.016; 67.25%±4.34% vs. 64.20%±3.37%, P=0.040). In addition, the awakening time of patients in the epinephrine group was shorter than that of the saline group (P=0.004), and the awakening time was associated with the duration of low-dose rScO2 (r=0.374). Conclusion    Continuous infusion of 0.01 μg/(kg·min) could improve the rScO2 during OLV and shorten awakening time in thoracic surgery.

Effect of early sleep intervention strategy on infantile physical growth and sleep awakening mode / 重庆医学

Objective To investigate the influence of intervention method on infantile physical growth and sleep awakening mode and its effect on infantile sleep problem.Methods Six hundreds healthy infants aged 1 month old voluntarily receiving health mangement in this hospital fnom May to August 2014 were selected and divided into the intervention group and control group.The sleep questionnaire was filled.All infants monthly received the common child health care conventional guidance follow up until 6 months old.The intervention group conducted the sleep cognition education and sleep problem consultation by the sleep specialist physicians issuing the infantile sleep health care education propaganda leaflets,then the the infants with sleep problems conducted the comprehensive intervention according to the sleep hel ath prescription.Results In the comparison of the infantile physical growth indicators,sleep awakening mode indicators and sleep problem occurrence rate between the two groups:(1) the infantile body height in the intervention group had obvious difference compared with the control group(P＜0.05).(2)The night waking frequency,night waking time,daytime sleep frequency and daytime sleep total time in the intervention group were significantly lower than those in the control group(P＜0.05),the night total sleep time in the intervention group was increased compared with the control group(P＜0.05),and the sleep latency,time to falling asleep and daytime naps time had no statistical difference between the intervention group and control group(P＞0.05).(3) In the sleep problems at 6 months old,the intervention group was significantly lower than the control group in the aspectof excessive night waking(P＜0.05),but the aspects of falling asleep overtime,awakening/going to bed rhythm disorder had no obvious difference between the two groups.Conclusion The early intervention strategy of cognitive behavioural intervention and health education can generate the favorable effect on the physical growth and sleep awakening mode in 0-6 months old infants and can reduce the occurrence of infantile sleep problems.

Effect of mindfulness music training on sleep-wakefulness behavior in patients with acute stress disorder sleep disorder with cerebral hemorrhage / 中国神经精神疾病杂志

Objective To explore the effect of mindfulness-based music therapy (MBMT) on sleep-wakefulness behavior in patients with acute stress disorder (ASD) coexisting sleep disorder with cerebral hemorrhage. Methods A total of 70 patients with cerebral hemorrhage and ASD coexisting sleep disorders were randomly divided into two groups (n=35 each group). The study group was treated with mindfulness and soothing music training on the basis of routine treatment for 28 consecutive days. The control group only received routine treatment. Polysomnography (PSG) was used to compare sleep-wake behavior before and after intervention. Results After the intervention, the numbers of awakenings, awakenings greater than 5 min, micro awakenings, NREM micro awakenings, micro awakenings in phase 1, micro awakenings in phase 2, and REM awakenings were decreased in both groups (P<0.05). The degree of reduction of those parameters were greater and the proportion of total sleep time to recording time was longer in the study group than in the control group (P<0.05). Conclusion Music therapy based on mindfulness can effectively improve the sleep-wakeful behavior of ASD patients with cerebral hemorrhage, change the sleep process, and improve their sleep quality.

Electroacupuncture of Multiple Acupoints Is Significantly Superior to That of Single Acupoint in Improving Sleep by Regulating Serum Sleep-promoting and Awakening-promoting Factors in Insomnia Rats / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture (EA) stimulation of single and multiple acupoints on sleep and concentrations of interlukin-1 β(IL-1 β), brain-derived neurotrophic factor (BDNF), prostaglandin D2(PGD2) and melatonin (MLT, sleep-promoting factors) and corticosterone (CORT, awakening-promoting factor) in the serum in insomnia rats, so as to explore its efficacy difference and the mechanism underlying improving sleep. METHODS: Fifty-four male SD rats were randomly divided into control, model, EA-Baihui (GV 20), EA-Shenmen (HT 7), EA-Sanyinjiao (SP 6) and EA-GV 20＋HT 7＋SP 6 groups (n＝9 rats in each group). The insomnia model was established by intraperitoneal injection of para-chlorophenylalanine (PCPA, 300 mg/kg) once daily for 2 days. In the EA-GV 20, EA-HT 7, EA-SP 6 and EA-GV 20＋HT 7＋SP 6 groups, EA stimulation was administrated for 30 min, once a day for 4 days. The sleep onset latency and sleep duration were measured after intraperitoneal injection of pentobarbital sodium (35 mg/kg). The concentrations of IL-1 β， BDNF, MLT, PGD2and CORT in the serum were detected by ELISA. RESULTS: After EA stimulation of GV 20, HT 7, SP 6 and GV 20＋HT 7＋SP 6, the sleep latency was significantly shortened (P<0.05, P<0.01, except SP 6), and the sleep duration was remarkably prolonged in comparison with the model group (P<0.05, P<0.01), and the therapeutic effects of EA-GV 20＋HT 7＋SP 6 were significantly superior to those of EA-GV 20, EA-HT 7 and EA-SP 6 in shortening the sleep latency and lengthening the sleep duration (P<0.05). Following modeling, the concentrations of IL-1 β， BDNF, PGD2 and MLT were significantly down-regulated, and the CORT level was markedly up-regulated in the model group relevant to the control group (P<0.05). Following EA，modeling induced dramatic decrease of serum IL-1 β， BDNF, PGD2 and MLT was considerably up-regulated, and the increased CORT level markedly down-regulated in the EA-GV 20, EA-HT 7, EA-SP 6 and EA-GV 20＋HT 7＋SP 6 groups (P<0.05). The effects of EA-GV 20＋HT 7＋SP 6 were evidently superior to those of EA-GV 20 and EA-SP 6 in up-regulating serum IL-1 β， BDNF and PGD2levels, and to those of HT 7, GV 20 and SP 6 in up-regulating serum MLT level, and significantly superior to those of EA-ST 7 and EA-SP 6 in down-regulating serum CORT (P<0.05). CONCLUSION: EA stimulation of HT 7, GV 20, SP 6 and GV 20＋HT 7＋ SP 6 can significantly improve the sleep in insomnia rats, which is closely associated with its effects in regulating serum sleep-promoting factors and awakening-promoting factor. Joint administration of EA of GV 20＋HT 7＋ SP 6 has a better effect than the single acupoint mentioned above.

The ABCDEF Implementation Bundle / 대한구급학회지

Long-term morbidity, long-term cognitive impairment and hospitalization-associated disability are common occurrence in the survivors of critical illness, with significant consequences for patients and for the caregivers. The ABCDEF bundle represents an evidence-based guide for clinicians to approach the organizational changes needed for optimizing ICU patient recovery and outcomes. The ABCDEF bundle includes: Assess, Prevent, and Manage Pain, Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT), Choice of analgesia and sedation, Delirium: Assess, Prevent, and Manage, Early mobility and Exercise, and Family engagement. The purpose of this review is to describe the core features of the ABCDEF bundle.

Relationship between diabetes mellitus and hypothalamic-pituitary-adrenal axis:A systematic review / 中华内分泌代谢杂志

Objective To provide objective evidences for early screening of the hypothalamic-pituitary-adrenal(HPA)axis function in diabetic patients, the relationship between HPA axis function and diabetes mellitus was systematically reviewed. Methods PubMed, Ovid, Embase, Web of science Databases were retrieved from articles reporting the relationship between HPA axis function and diabetes mellitus. Meta-analysis were carried out by Stata 12. 0 software for heterogeneity test and data merged among articles for the inclusion and exclusion criteria. Results Our meta-analysis showed the following results: Compared with control group, the basal plasma cortisol level in total diabetes group, T1DM group, T2DM group, diabetes patients(with or without chronic complications)combined with hypertension was significantly higher. Compared with control group, postdexamethasone cortisol level was markedly higher in diabetes group. There was no significant difference in 24 h urinary free cortisol(24h UFC)and ACTH levels between diabetes group and control group. Our qualitative evaluation shows the following results: the differences of awaking salivary cortisol and cortisol awakening response(CAR)between the two groups were inconsistent among all included studies. Most studies showed that CAR was lower in diabetic patients. Conclusion The present analysis has demonstrated that HPA axis dysfunction exists along with diabetes mellitus, and diabetic comorbidity may further worsen the HPA axis dysfunction.

Cardiovascular influence of continue pumped dexmedetomidine in double -lumen tube inserted patients / 中国基层医药

Objective To observe the effect of continuous pumped dexmedetomidine on hemodynamics, awakening quality and stress response in double -lumen tube extubation patients.Methods 60 patients with thoracic surgery were divided into saline group(group N,n =30)and Dex group(group D,n =30).Both two groups were continuously pumped NS and dexmedetomidine respectively 20min before anesthesia.MAP,HR and SpO2 at different time points during the surgery were recorded.Extracted 5ml arterial blood at the time point of T0 and T3,centrifugated and stored at -80 ℃ for testing renin levels.The extubation time,restlessness incidence,orientation recovery time, extubation quality score were recorded.Results The values of MAP in group D at time points of T0,T1,T2,T3,T4 were (97 ±15)mmHg,(102 ±12)mmHg,(103 ±11)mmHg,(98 ±12)mmHg,(96 ±13)mmHg.The values of HR in group D at different time points were (69 ±9)times/min,(80 ±6)times/min,(90 ±7)times/min,(74 ±5)times/min,(73 ±6)times/min.The values of SpO2 in group D at different time points were (95 ±3)%,(98 ±2)%,(98 ± 2)%,(95 ±3)%,(96 ±2)%.The values of MAP in group N at time points of T0,T1,T2,T3,T4 were (96 ± 15)mmHg,(112 ±16)mmHg,(120 ±12)mmHg,(117 ±14)mmHg,(102 ±15)mmHg.The values of HR in group N at different time points were (68 ±7)times/min,(84 ±8)times/min,(105 ±6)times/min,(89 ±6)times/min, (80 ±7)times/min.The values of SpO2 in group N at different time points were (96 ±2)%,(98 ±2)%,(97 ± 3)%,(93 ±3)%,(92 ±4)%.The values of MAP,HR,SpO2 at different time points in group D were significantly lower than those in group N,the differences were statistically significant (the t values of MAP at different time points were tT1 =2.74,tT2 =5.72,tT3 =25.63,tT4 =1.66,all P <0.05;the t values of HR at different time points were tT1 =2.20,tT2 =8.91,tT3 =10.52,tT4 =4.16,all P <0.05;the t values of SpO2 at different time points were tT1 =0.00,tT2 =1.52,tT3 =2.58,tT4 =4.9,PT3 <0.05,PT4 <0.05).There was significant difference between the two groups in orientation recovery time[(3.3 ±2.2)min vs (5.2 ±2.3)min,P =0.0018].There was significant difference between the two groups in agitation score[(1.3 ±0.9)vs (2.4 ±1.2)].There was significant difference between the two groups in extubation quality score[(2.1 ±1.2)vs (3.2 ±1.4),P =0.0018].There was statistical difference between the two groups in T3 adrenal hormones[(N:120 ±25.3)pmol/L,(D:93.4 ±23.2)pmol/L,P =0.00].The dose of sufentanil (60.5 ±9.2)μg in group N was higher than (40.4 ±10.2)μg in group D (P =0.001).The dose of remifentanil (3.3 ±0.8)mg in group N was higher than (2.4 ±0.9)mg in group D (P =0.001).Conclusion Continuous pumped dexmedetomidine can effectively improve awakening quality of patients with double -lumen tube.

The ABCDEF Implementation Bundle / 대한중환자의학회지

Long-term morbidity, long-term cognitive impairment and hospitalization-associated disability are common occurrence in the survivors of critical illness, with significant consequences for patients and for the caregivers. The ABCDEF bundle represents an evidence-based guide for clinicians to approach the organizational changes needed for optimizing ICU patient recovery and outcomes. The ABCDEF bundle includes: Assess, Prevent, and Manage Pain, Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT), Choice of analgesia and sedation, Delirium: Assess, Prevent, and Manage, Early mobility and Exercise, and Family engagement. The purpose of this review is to describe the core features of the ABCDEF bundle.